Risk of cardiac arrhythmias after electrical accident: a single-center study of 480 patients.

OBJECTIVE: Patients with electrical injury are considered to be at high risk of cardiac arrhythmias. Due to the small number of studies, there is no widely accepted guideline regarding the risk assessment and management of arrhythmic complications after electrical accident (EA). Our retrospective observational study was designed to determine the prevalence of ECG abnormalities and cardiac arrhythmias after EA, to evaluate the predictive value of cardiac biomarkers for this condition and to assess in-hospital and 30-day mortality. METHODS: Consecutive patients presenting after EA at the emergency department of our institution between 2011 and 2016 were involved in the current analysis. ECG abnormalities and arrhythmias were analyzed at admission and during ECG monitoring. Levels of cardiac troponin I, CK and CK-MB were also collected. In-hospital and 30-day mortality data were obtained from hospital records and from the national insurance database. RESULTS: Of the 480 patients included, 184 (38.3%) had suffered a workplace accident. The majority of patients (96.2%) had incurred a low-voltage injury (< 1000 V). One hundred and four (21.7%) patients had a transthoracic electrical injury while 13 (2.7%) patients reported loss of consciousness. The most frequent ECG disorders at admission were sinus bradycardia (< 60 bpm, n = 50, 10.4%) and sinus tachycardia (> 100 bpm, n = 21, 4.4%). Other detected arrhythmias were as follows: newly diagnosed atrial fibrillation (n = 1); frequent multifocal atrial premature complexes (n = 1); sinus arrest with atrial escape rhythm (n = 2); ventricular fibrillation terminated out of hospital (n = 1); ventricular bigeminy (n = 1); and repetitive nonsustained ventricular tachycardia (n = 1). ECG monitoring was performed in 182 (37.9%) patients for 12.7 ± 7.1 h at the ED. Except for one case with regular supraventricular tachycardia terminated via vagal maneuver and one other case with paroxysmal atrial fibrillation, no clinically relevant arrhythmias were detected during the ECG monitoring. Cardiac troponin I was measured in 354 (73.8%) cases at 4.6 ± 4.3 h after the EA and was significantly elevated only in one resuscitated patient. CK elevation was frequent, but CK-MB was under 5% in all patients. Both in-hospital and 30-day mortality were 0%. CONCLUSIONS: Most of cardiac arrhythmias in patients presenting after EA can be diagnosed by an ECG on admission, thus routine ECG monitoring appears to be unnecessary. In our patient cohort cardiac troponin I and CK-MB were not useful in risk assessment after EA. Late-onset malignant arrhythmias were not observed.

GHB-involved crimes among intoxicated patients.

INTRODUCTION: In recent years, the involvement of GHB in drug facilitated sexual assaults has been one of the most frequently studied aspects of GHB in both clinical and non-clinical settings. GHB-involved acquisitory crimes, however, can be mentioned as understudied research topics, as well as the poisoning severity properties of GHB. MEASURES: The medical reports of Péterfy Sándor Street Hospital Clinic and Casualty Centre's 408 GHB-intoxication cases (352 patients) were reviewed and registered. Analyzed data consisted of epicrisis, serum and urine concentration of various substances (including GHB), scores of Glasgow Coma Scale and Poisoning Severity Score. RESULTS: Majority of the patients were males, in their twenties. GHB was detected in 34.1% and it was solely consumed in 27.7% of all the cases. Ethanol was found to be the most frequently co-ingested substance. A higher rate of severe poisonings was observed among males. We found significant difference in the frequency of enduring sexual assaults and acquisitory crimes between intentional and unintentional GHB intake cases. Among unintentional GHB intake cases, 6.5% endured GHB-involved sexual assaults, whereas 21.7% endured an acquisitory crime. Among recurrent GHB intoxication cases generated by the same patients, voluntary and sole GHB consumptions were more frequently observed, however, enduring any crime was less characteristic. DISCUSSION: Our results regarding demographic and substance use characteristics and the frequency of GHB-facilitated sexual assaults are in line with former findings. Enduring acquisitory crimes due to unintentional GHB intake was found to be more inherent than enduring sexual assaults. Authors emphasise that the victims of these acquisitory crimes were typically males. CONCLUSION: GHB's role in drug facilitated acquisitory crimes seems to be significant, although the decrease in GHB's popularity is observed among intoxicated patients as well. The need for further research on GHB's impact on cognitive impairment and on sexual correlates of intentional GHB use is addressed by the authors.

Enhancing sexual desire and experience: an investigation of the sexual correlates of gamma-hydroxybutyrate (GHB) use.

OBJECTIVE: Various studies have dealt with gamma-hydroxybutyrate's (GHB) potential role in sexual assaults, while the sexual correlates of intentional recreational GHB use have not well been highlighted. Our study aims to explore GHB's sexual effects, the patterns of choice of sexual partners, the frequency of experienced blackouts, and endured sexual or acquisitory crimes as a result of GHB use. METHODS: Sixty recreational GHB users filled out a questionnaire on experienced subjective, somatic, and sexual effects of GHB, the frequency of blackouts due to their GHB use, and items on their sexual experiences in relation to GHB use. RESULTS: Of the sample, 25.9% reported increased sexual arousal as well as more intense attraction towards their sexual partners and increased sexual openness when using GHB; 34.8% had sexual intercourse with strangers, or with others, but not with their partners when using GHB; and 8.6% were victims of acquisitory crimes, whereas 3.4% were victims of a sexual assault. Furthermore, 24.6% typically experienced blackouts when using GHB. CONCLUSION: Gamma-hydroxybutyrate seems to be a potential substitute for both stimulant and depressant substances. Increased sexual desire and disinhibition may lead to a more frequent and potentially more riskful sexual activity. Experienced blackouts need to be considered as risk factors for suffering sexual or acquisitory crimes.

[Urgent cesarean section in a pregnant woman with carbon monoxide poisoning]. / Sürgosségi császármetszés szén-monoxid-mérgezésben.

Recognition of carbon monoxide is difficult due to its plain physical-chemical properties. Carbon and gas operating heating systems may cause severe poisoning. Carbon-monoxide intoxication may generate severe hypoxic damage and it may cause death. The authors present the case of severe carbon monoxide poisoning affecting one young child and five adults, including a pregnant woman. Because the availability of hyperbaric oxygen therapy is limited in Hungary, urgent cesarean section was performed to avoid intrauterine hypoxic damage. The authors note that there are no standardized non-invasive methods for measuring fetal carbon-monoxide level and that the level of carbon monoxide accumulation is higher and the clearance is longer in the fetus than in the mother. The pathophysiology of carbon monoxide intoxication and therapeutic options in pregnancy are discussed.

Substitutional potential of mephedrone: an analysis of the subjective effects.

OBJECTIVE: In the past 25-30 years, a large number of synthetic and non-synthetic drugs have appeared on the recreational scene, but with the exception of 4-methylmethcathinone (mephedrone), none of these substances reached the popularity of ecstasy [3,4-methylenedioxy-N-methylamphetamine, (MDMA)]. Authors aimed to determine the subjective effects of mephedrone in order to understand how mephedrone can serve as a potential substitute for entactogens, such as MDMA. METHODS: One hundred forty-five mephedrone users--recruited by snowball method--filled out a questionnaire on their patterns of use and experienced subjective effects of mephedrone. RESULTS: Factor analysis revealed six factors of mephedrone-induced subjective effects: positive emotions, sensibility, adverse somatic effects, adverse psychological effects, stimulant effects, and psychedelic effects. A preference list of subjective effects indicates that mephedrone is popular primarily for its psychostimulant and entactogen effects. Latent class analysis identified two classes of mephedrone users, with closely parallel profiles. The two classes differed in severity of subjective experience in a way that was consistent across the six dimensions. CONCLUSIONS: By having similar subjective effects as MDMA and other entactogens, mephedrone seems able to substitute other enactogenic stimulants.

[An overview on envenomings inflicted by the Common adder (Vipera berus) and their treatment in Hungary. Facts and beliefs -- part I]. / Górcso alatt a keresztes vipera (Vipera berus) által okozott marások és kezelésük Magyarországon. Tények és hiedelmek - I. rész.

Consequences of bites by the Common adder (Vipera berus) were reviewed in this study. Patients bitten by snakes from different populations may develop variable symptoms due to geographical venom variation. The correct diagnosis of snake bites and the knowledge of the distribution of venomous snake taxa have a crucial impact on snake bite therapy. The characteristic symptoms of patients bitten by V. berus in Hungary are highlighted. The habitat characteristics, seasonal activity and the Hungarian distribution of the adder are described based on literature data, museum specimens and field observations. However, envenomings are uncommon in Hungary, the annual 3 to 4 incidents have to be taken seriously, regardless of the age and actual health condition of the patients. Contrary to beliefs persisting both among laymen and professionals, the venom of V. berus is powerful. Medical observation of the patients is necessary in the first 5 to 6 hours. Any systemic symptom or progression of the edema requires hospital admission.

Clinical picture of envenoming with the Meadow Viper (Vipera (Acridophaga) ursinii).

OBJECTIVE: The vipers in the Vipera (Acridophaga) ursinii complex are small-sized insectivorous snakes found in parts of central and southern Europe. Subspecies include Vipera ursinii ursinii, Vipera ursinii moldavica, Vipera ursinii macrops, Vipera ursinii rakosiensis, and Vipera ursinii graeca and are commonly known as the meadow vipers. These are the least known European Vipera from a clinical point of view. METHODS: We identified cases of V. ursinii envenomations through three methods, including literature search in PubMed, ISI web of Knowldge, JSTOR, Biological Abstracts, Zoological Record, using the various combination of the following terms: snakebite, envenoming, bite, venom, ursinii, meadow viper, steppe viper (in English, French, Italian, Hungarian, Croatian, Serbian, Romanian), review of paper-based medical case records of hospitals in Hungary (four) and Romania (one) covering the 1970-July 2010 period, and personal communications of professional and amateur herpetologists studying V. ursinii and snake-handlers bitten by these snakes. RESULTS: We identified 64 cases from subspecies: V. u. ursinii (14), V. u. moldavica (8), V. u. macrops (5), and V. u. rakosiensis (37). Forty-five bites were collected from the literature, 5 from hospitals, 10 cases were communicated by seven herpetologists and four cases by two snake keepers. Bites were mostly asymptomatic. Forty-five envenomings (70%) resulted in mild and moderate local symptoms, involving pain with low-intensity, pruritus, numbness, swelling with or without erythema and/or local hematoma. Bullae (n = 3, 5%), mild superficial necrosis (n = 4, 6%), cellulitis (n = 1, 2%), and moderately extended edema (n = 8, 13%) of the bitten extremity rarely develop. Massive limb edema was recorded in eight (13%) cases. The most common systemic symptoms were dizziness caused by transient hypotension and tachycardia. Gastrointestinal disorders (i.e. nausea, vomiting) were rare (n = 2, 3%) compared to other Vipera, and probably triggered only by anxiety. Symptomatic and supportive therapy was applied in the relatively severe envenomings and antivenom therapy in six cases. Complete recovery ranged from 12 h to 2 weeks. Moderate and severe envenomings required significantly longer recovery. Application of first aid was associated with significantly longer recovery times. Neither the age (i.e. juvenile or adult) of the culprit specimen, nor the anatomical location of the bite determined the severity of symptoms. CONCLUSION: Professional and amateur herpetologists, and snake keepers are mainly at risk. Most V. ursinii bites do not require first aid or medical intervention, since only local symptoms develop and resolve spontaneously. The rare hospitalized cases require symptomatic and supportive treatment only. Antivenom therapy is not indicated.

[Total upper lip necrosis and loxoscelism caused by violin spider bite]. / Pókcsípés okozta loxoscelizmus nagykiterjedésu felso ajak nekrózissal.

Arthropods and in particular spiders are a common embodiment of our fears, despite the fact that only a few species are dangerous to man. The authors present a case involving severe local and general reactions to a loxosceles (brown recluse spider) bite. They give an overview of the occurrence of loxosceles spiders, the signs and symptoms of envenomation and the therapeutic possibilities. The severe symptoms presenting following loxosceles envenomation is termed loxoscelism. Loxoscelism is characterised by local soft tissue necrosis of varying degree at the site of the sting, and rarely, life-threatening general reactions, such as haemolysis with ensuing anaemia, and renal failure. Therapeutic interventions following loxosceles bites range from dapsone treatment to hyperbaric oxygen therapy, but the most promising therapy is the use of the antiserum, commercially available in certain South-American countries where loxosceles bites are common. Treatment of soft tissue necrosis consists of necrectomy and surgical reconstruction following the resolution of the inflammatory symptoms.

[Prognosis in acute digitalis poisoning]. / Prognózisbecslés akut digitáliszmérgezésben.

INTRODUCTION: Acute digitalis overdosage is characterized by high electric instability, its mortality may reach 10-15 percent even nowadays. PURPOSES: To detect the possible risk factors which might predict severe intoxication. METHODS: Data of 50 patients treated at authors' department with acute digoxin poisoning over the past 8 years could be retrospectively evaluated. Cases were classified according to the Poison Severity Score (PSS). The following parameters were taken into consideration: age, sex, diseases influencing the severity of intoxication, dose of the drug, heart frequency, serum potassium and digoxin levels and vomiting. For statistical analysis a Kruskal-Wallis test and a chance-quotient calculation was applied. RESULTS: From 50 patients 30 were mild (PSS 1, 2), 20 were severely poisoned, which subgroup included 8 deaths (PSS 4) and 12 patients who recovered (PSS 3). Based on Kruskal-Wallis test significant differences were found in the following items: greater number of primary diseases PSS 4 vs other subgroups (p < 0.05); bradycardia PSS 4 vs PSS 2 (p < 0.05) and PSS 3 vs PSS 2 (p < 0.05); hyperkalaemia PSS 3 vs PSS 2 (p < 0.01); elevated serum digoxin level PSS 3 vs PSS 2 (p < 0.05). The risk of severe poisoning (PSS 3-4) was increased in case of hyperkalaemia, bradycardia, vomiting (p < 0.001), and if the patients' age and if the drug dose exceeded 65 years or 10 mg, respectively (p < 0.05). CONCLUSIONS: The predictive risk factors concerning severe acute digoxin poisoning are profuse vomiting, hyperkalaemia and bradycardia. The predictive risk factors of fatal outcome are age over 65 years associated with primary disease, vomiting and bradycardia.